Elbow Injuries

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Elbow Injuries
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FYI

• Functions with any upper extremity movement.
• Prone to muscle and tendon injuries because it is
  the sight of many muscle attachments.

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Anatomy

• Hinge joint
• 3 major bones humerus, radius, and ulna.
• Ulna is hooked to the end of the humerus and
  forms a tight joint.
• Radius is on the thumb side of the forearm.
• Able to rotate, causing supination and pronation
  of the forearm.

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Ligaments

• Joint capsule (a ligament) surrounds the elbow
  and gives some general stability to the joint.
• Other primary ligaments that provide stability
• Ulnar collateral-stabilize the medial aspect
• Radial collateral-stabilize the lateral aspect
• Annular collateral-helps hold the radius and ulna
  together near the elbow joint
• Interosseus membrane-tissue that joins the radius
  and ulna from the elbow to wrist and keeps the
  two bones from separating.

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Muscles

• Triceps-primarily performs elbow extension
• Biceps-primarily performs elbow flexion.
• Wrist flexors-attach to the medial epicondyle of
  humerus
• Wrist extensors-attach to the lateral epicondyle
  of humerus
• epicondyle-rounded articular area.
• both muscles help stabilize the elbow.

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Preventing Elbow Injuries

• Not a frequently injured joint.
• Most injuries seen at the elbow joint are caused
  by overuse.
• Most athletes pay more attention to strengthening
  the biceps and triceps, and they fail to properly
  condition some of the smaller muscles of the
  wrist (vital to preventing overuse injuries).

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Ligament Injuries

• Sprains classified as first, second, or third
  degree.
• Ulnar collateral seem to be more prone to sprains
  than the other ligaments
• Especially in athletes who throw, due to the
  amount of stress placed on the medial aspect of
  the elbow.

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Valgus Stress

• Forcing the medial aspect of the joint to
  separate or spread apart as the forearm moves
  laterally
• Characterized by medial elbow pain and swelling.
• Joint laxity may be present.
• Treated using PRICE
• Rehab strengthening the wrist flexors

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Radial Collateral Injuries

• Very rare
• Same characteristics of ulnar collateral injuries
  except the pain and swelling would be on the
  lateral side.
• Rehab strengthening the wrist extensors

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Muscle and Tendon Injuries

• Strains often caused by either excessive
  resistive forces or overuse.
• Can occur to elbow flexors or extensors, as well
  as to the wrist flexors and wrist extensors

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Elbow Flexor Strain

• Often caused by a loaded movement that includes
  the elbow and shoulder together.
• two-joint muscles are very prone to strains.
• Muscles involved with creating movement at more
  than one joint
• Ex. Biceps-flexes elbow and shoulder

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Degrees of a Flexor Strain

• Minor-characterized by discomfort at the anterior
  aspect of the elbow and minimal swelling. Some
  weakness when elbow flexion is resisted.
• Moderate-mild to moderate amounts of swelling and
  marked weakness.
• treated with PRICE
• Complete rupture needs to be referred to team
  physician

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Elbow Extensor Strain

• Excessive resistance to the triceps muscle will
  often cause tissue damage to the elbow extensors.
• Needs to be assessed carefully because the
  triceps tendon can often pull a bit of bone away
  from the ulna.
• Characteristics are the same as a flexor strain
  except the pain will be at the posterior aspect.
• Treatment PRICE

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Wrist Flexor Strains

• Caused by excessive resistance during wrist
  flexion movements or from overuse.
• Result in pain over the medial epicondyle of the
  humerus or the front of the forearm.
• Treated with PRICE and activity should be modified

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Wrist Extensor Strains

• Caused by excessive resistance during wrist
  extension movements or overuse
• Result in pain over the lateral epicondyle of the
  humerus.
• Treated with PRICE and activity should be
  modified.

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Lateral Epicondylitis

• Caused by poor mechanics and continual use over a
  long period of time.
• Racquet sports are the most common cause
• Aka Tennis Elbow
• Characterized by pain over the lateral epicondyle
  of the humerus and minimal swelling.
• Treatment PRICE, a support, and limiting
  activity

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Medial Epicondylitis

• Not as common as lateral epicondylitis.
• Often a result of repetitive throwing.
• Aka Little League elbow
• Treatment PRICE and limiting activities.

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Bone Injuries

• Fractures to the distal end of the humerus are
  not common.
• If they do occur, it is often due to a very
  powerful mechanism
• Ex. Hand being planted on the ground and someone
  forcing the arm into excessive side bending.
• ATC must consider any type of elbow fracture an
  emergency because they can result in compression
  of an artery or nerve

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Epiphyseal and Avulsion Fractures

• More common on the medial eipcondyle or olecranon
  aspect
• Olecranon-process of the ulna projecting behind
  the elbow joint.
• Epiphyseal injury suspected whenever there is
  swelling, pain, and loss of movement.
• Severe pain and deformity indicate an avulsion
  fracture.
• Either injury should be referred to a team
  physician

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Ulna Dislocation

• Elbow is one of the most commonly dislocated
  joints in the body.
• Takes a very traumatic injury to dislocate the
  ulna from the humerus.
• Violent hyperextension or a severe blow to the
  lateral aspect of the elbow
• Obvious deformity
• Should be immediately splinted in the position in
  which it is found
• Needs to be reduced by a physician

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Olecranon Bursitis

• Happens when the olecranon process is contused.
• Olecranon bursa becomes irritated
• Causes a lot of fluid to build up at the tip of
  the elbow
• Rarely disabling, but build up can become the
  size of a golf ball.
• Treatment compression wrap or may need to be
  drained.
• Padding may need to be applied to protect the
  elbow from further bruising.

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Pics of olecranon bursitis